Compared to the Occidental upper eyelid, the Asian upper eyelid crease forms closer to the eyelashes, is not as deep, and is often poorly defined or broken into multiple folds. In about half of Asian people, the crease is entirely absent. Asian blepharoplasty helps to create what is sometimes called a double eyelid, a term that refers to a lid segmented into two visible parts by a noticeable fold.
The Asian eyelid may appear relatively puffy due to the downward extension of normal fat much closer to the lashes. The fat pad just below the eyebrow (retro-orbicularis oculi fat, or ROOF) is often thicker and located in a lower position.
The skin of the Asian upper eyelid tends to grow baggier at an earlier age.
A tiny crescent of skin, or epicanthal fold, may exist between the eyelid corner and the nose. The eyelid crease, when present, may appear to dive down and blend into it.
Because the eyelashes of the less-creased Asian eyelid can bend downward, the opening between the upper and lower eyelids may appear partially obstructed.
These differences between Asian and Occidental eyelids are determined by the various ways in which the eight distinct layers of the lid attach to or interact with one another. Of paramount importance is the absence of fibrous extensions from the deeper levator muscle (opening muscle) to the more superficial pre-tarsal orbicularis muscle (part of the closing muscle located just beneath the skin), which, in the Occidental eyelid, blocks fat from entering the lower part of the lid and creates a skin indentation (crease) when the eye is opened.
Just as there are fundamental differences between Asian and Occidental eyelids, there are also distinct anatomical differences between and within the many subgroups of Asian heritage (Japanese, Chinese, Korean, and so on) as well as differences introduced by the blending of subgroups through intermarriage. A surgeon must be well-versed in eyelid anatomy and be able to recognize subtle variations so that the operation may be adjusted accordingly.
